老年高脂血症性急性胰腺炎临床特点及预后评估因素分析

The clinical value of clinical characteristics and prognosis of elderly patients with hyperlipidemic acute pancreatitis

目的探讨老年高脂血症性急性胰腺炎(HLAP)的临床特点,同时考察C反应蛋白(CRP)、降钙素CT以及降钙素原(PCT)在HLAP严重程度评价中的作用及其对HLAP预后评估的临床价值。方法选取上海中医药大学附属普陀医院2012年7月至2015年7月收治的148例老年胰腺炎患者,其中,76例HLAP患者为观察组,72例胆源性急性胰腺炎(BAP)患者为对照组。对两组患者的临床特征进行比较分析;同时,总结收治的76例HLAP患者,按诊断标准分为急性轻症胰腺炎组(MAP)和急性重症胰腺炎组(SAP)两组,比较两组患者降脂前后Ranson和CT评分,以及两组患者血脂和CRP水平。结果在临床评分相同的情况下,与BAP患者比较,HLAP患者糖尿病发生率、脂肪肝发生率和血脂水平均较高,肝功能受损程度和血清淀粉酶水平较低,差异均有统计学意义(P<0.05)。与MAP组比较,SAP组患者的CRP、甘油三脂均显著增高(P<0.05)。结论与一般急性胰腺比较,老年HLAP具有血脂高、病情重、复发率高、并发症多、血清淀粉酶低等特点,CRP联合高血脂可作为评判HLAP严重程度的评价指标。CRP、CT以及PCT对老年HLAP的预后评估具有方便、可行、可较早诊断等临床价值。

Objective To investigate the clinical characteristics of elderly patients with hyperlipidemia acute pancreatitis,and the effects of C reactive protein（ CRP） and computed tomography（ CT） and calcitonin angiotensinogen（ PCT） in hyperlipidemia pancreatitis severity assessment of effect of the high-fat hyperlipidemia acute pancreatitis prognosis assessment of clinical value. Methods A total of 148 cases of elderly patients with pancreatitis received in Shanghai Putuo District Center Hospital from July 2012 to July 2015.Among the total cases,76 cases of patients with hyperlipidemia acute pancreatitis（ HLAP） were in the observation group,72 cases of patients with acute biliary pancreatitis（ BAP） were in the control group. The clinical characteristics of patients in two groups were compared and analyzed. The 76 cases of high lipid of hyperlipidemic acute pancreatitis（ AP） in patients,according to the diagnostic criteria divided into to two groups of acute mild pancreatitis group（ MAP） and severe acute pancreatitis group（ SAP）,lipid of the patients in two groups were compared before and after the Ranson and CT Score,and two groups of blood lipid and CRP levels. Results With the same clinical score,acute hyperlipidemia pancreatitis with biliary pancreatitis compared to the incidence of diabetes,fatty liver incidence and high levels of fat in the blood,liver function damage and the serum amylase level were low,the difference was statistically significant（ P〈0. 05）. Compared with SAP group and MAP group,CRP,glycerin three fat increased significantly（ P〈0. 05）.Conclusion The elderly patients with HLAP and acute pancreatic compared with high blood lipids,severe illness,recurrence rate high,more complications,serum amylase are low and the same to the characteristic,CRP combined hyperlipidemia can judge high lipid of hyperlipidemic acute pancreatitis severity as evaluation index. C reactive protein（ CRP）,CT and procalcitonin on prognosis of elderly patients with hyperlipidemic acute pancreatitis evaluation is convenient and feasible,has early diagnosis clinical value.